Gestational Age Of Patients Research Articles

Maternal and Perinatal Outcome in Hypertensive Disorders of Pregnancy - A Retrospective Study

Background: It was a retrospective observational study to know demographic factors, maternal and perinatal outcome in patients of hypertensive disorders of pregnancy admitted in a medical college and tertiary health care center. Introduction: Hypertensive disorders of pregnancy are one of the important cause of maternal morbidity and mortality in India. Hypertensive Disorders of Pregnancy (HDP) account for nearly 18% of all maternal deaths worldwide. Delivery at early gestational age in patients of HDP is associated with high perinatal morbidity and mortality resulting from prematurity. Method: Total number of 120 cases of hypertensive disorders of pregnancy admitted in our hospital was included in the study after satisfying inclusion and exclusion criteria. We studied demographic factors as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 40% were in the age group of 21-30 yrs. 61% of patients were primi gravida and 25% of patients were second gravida. Maximum number of patients had gestational age ≥ 32 weeks at the time of delivery. 26.6% patients, 73.4% patient’s and 12.5% patients were diagnosed as gestational hypertension, preeclampsia and eclampsia respectively. There was high incidence of HELLP and eclampsia in 12.5% each, DIC in (5%), APH in (4.1%), renal complications in (3.3%) and CNS complication were seen in 0.8%. 67.5% patients were delivered by vaginal route, 32.50% patients required LSCS. Majority of patients i.e., 60% underwent preterm delivery, 34% delivered at term. Maternal mortality occurred in 8 patients (6.67%). HELLP and DIC were the leading causes of death. 70% patients had good perinatal outcome. There were 25.83% still births and 4.17% neonatal deaths. Conclusion: Hypertensive disorders of pregnancy are associated with increased maternal and perinatal morbidity and mortality. Good antenatal care, health education, early diagnosis, early referral to higher center and multidisciplinary approach will reduce morbidity and mortality in mother and baby.

Prognostic role of hyperhomocysteinemia in prolonged pregnancies according to the ROC-analysis findings

Objective: To evaluate the clinical and prognostic role of homocysteine in pregnant women with prolonged pregnancy. To study the features of delayed delivery and perinatal outcomes in this case, we analysed 96 pregnant women with prolonged delivery during 2013-2015., who gave birth to children in the period of 41-42 weeks. As a control group we examined 41 pregnant women, who, for clinical and demographic characteristics, did not differ from the comparison group, but with delivery in time 37-40 weeks. Thus, depending on the patient's gestational age they were divided into 2 groups: group 1 included 41 patients, delivering with the term of gestation 37-40 weeks, group 2 – 96 patients, delivering after 41- 42 weeks of pregnancy. The level of homocysteine in the group with prolonged pregnancy (10,76 mmol/L) exceeded the figure in the control group significantly (7,72 mmol/L) (p<0.05). Risk assessment by ROC-analysis and logistic regression allows to calculate the critical value of homocysteine (9,5 mmol/L) which is associated with a high risk of complications (area under the ROCcurve is more than 90 %). The proposed method for predicting complications by using homocysteine serum level has a very high sensitivity (87,5 %), specificity (84,21 %), positive and negative predictive significance (85,37 % and 86,49 %, respectively) relative to the diagnosis of high risk complications of prolonged pregnancy. Women with high homocysteine reliably showed adverse changes in the functioning of the fetoplacental complex. According to the chi-squared, the homocysteine level over 9,5 mmol/L recorded statistically significantly fewer pregnant women with normal levels of progesterone (χ2=17,2 at p<0,01). According to the conducted regression analysis of the relationship between size of homocysteine and pulsation index (PI) cord statistically approximated logarithmic regression model (exponential) type pulsation index PI=-0,04+0,89*log10(homocysteine). Designed interdependence which is gradually growing exponentially, shows that more than half the dispersion characteristics pulsation index (PI) cord can be explained by the change in the concentration of homocysteine blood, and the greatest growth function was observed in the range of more than 14 mg/l of homocysteine, where in most cases there were a disorder in the uterine blood flow (PI over 1 IU).

The use of neonatal inpatient medication charts in a principal referral and specialist hospital for women and newborns

A neonatal inpatient medication chart audit was conducted at King Edward Memorial Hospital in 2012 and again in 2014 to investigate and compare the effective use of the newly implemented chart. Two main aspects of the medication charts were investigated: patient characteristics and medication prescriptions. Following the audit in 2012, improvement strategies and educational activities were implemented to improve the completion of the unsatisfactory fields in the medication charts. Posters highlighting audit results were displayed in the ward areas. The pharmacists also participated in the half‐yearly hospital orientation sessions for junior doctors, emphasising safe prescribing and common prescribing errors in the hospital. Computer screen savers on medication safety were set as default screen savers on all computers in the hospital. The percentage of medications with complete dose increased from 98.21% in 2013 to 99.61% in 2014. Other improvements included complete medication name, route, frequency, clear prescriber name, patient's gestational age and correct patient identification stickers. The multi‐faceted interventions were associated with a modest improvement in the use of the neonatal inpatient medication chart.

Constructing the meaning of ultrasound viewing in abortion care.

As ultrasound scanning becomes increasingly routine in abortion care, scholars and activists have forwarded claims about how viewing the ultrasound image will affect pregnant women seeking abortion, speculating that it will dissuade them from abortion. These accounts, however, fail to appreciate how viewing is a social process. Little research has investigated how ultrasound workers navigate viewing in abortion care. We draw on interviews with twenty-six ultrasound workers in abortion care for their impressions and practices around ultrasound viewing. Respondents reported few experiences of viewing dissuading women from abortion, but did report that it had an emotional effect on patients that they believed was associated with gestational age. These impressions informed their practices, leading many to manage patient viewing based on the patient's gestational age. Other aspects of their accounts, however, undercut the assertion that the meaning of ultrasound images is associated with gestation and show the pervasiveness of cultural ideas associating developing foetal personhood with increasing gestational age. Findings demonstrate the social construction of ultrasound viewing, with implications in the ongoing contestation over abortion rights in the US.

Rapid Intrahost Evolution of Human Cytomegalovirus Is Shaped by Demography and Positive Selection

Populations of human cytomegalovirus (HCMV), a large DNA virus, are highly polymorphic in patient samples, which may allow for rapid evolution within human hosts. To understand HCMV evolution, longitudinally sampled genomic populations from the urine and plasma of 5 infants with symptomatic congenital HCMV infection were analyzed. Temporal and compartmental variability of viral populations were quantified using high throughput sequencing and population genetics approaches. HCMV populations were generally stable over time, with ∼88% of SNPs displaying similar frequencies. However, samples collected from plasma and urine of the same patient at the same time were highly differentiated with approximately 1700 consensus sequence SNPs (1.2% of the genome) identified between compartments. This inter-compartment differentiation was comparable to the differentiation observed in unrelated hosts. Models of demography (i.e., changes in population size and structure) and positive selection were evaluated to explain the observed patterns of variation. Evidence for strong bottlenecks (>90% reduction in viral population size) was consistent among all patients. From the timing of the bottlenecks, we conclude that fetal infection occurred between 13–18 weeks gestational age in patients analyzed, while colonization of the urine compartment followed roughly 2 months later. The timing of these bottlenecks is consistent with the clinical histories of congenital HCMV infections. We next inferred that positive selection plays a small but measurable role in viral evolution within a single compartment. However, positive selection appears to be a strong and pervasive driver of evolution associated with compartmentalization, affecting ≥34 of the 167 open reading frames (∼20%) of the genome. This work offers the most detailed map of HCMV in vivo evolution to date and provides evidence that viral populations can be stable or rapidly differentiate, depending on host environment. The application of population genetic methods to these data provides clinically useful information, such as the timing of infection and compartment colonization.

Prematurity prevention: the role of acute tocolysis

The preterm birth rate in the United States remains at an all-time high and continues to rise. Acute tocolysis has potential to delay preterm birth for 48 h, the critical period of antenatal steroid administration, or to arrest an episode of preterm labor, thus delaying birth and improving neonatal outcomes. It is therefore paramount that medical providers remain up-to-date regarding the usefulness, indications and contraindications, and side-effects and adverse effects of all tocolytics. Magnesium sulfate remains the most common tocolyic agent in the United States. Recent evidence comparing oral nifedipine with magnesium sulfate suggests equal efficacy with fewer maternal side-effects, thus supporting this oral medication as first-line treatment. This review will summarize the most common acute tocolytic drugs, their methods of action, and clinical data regarding their utility. All tocolytic medications have side-effects, some of them potentially life-threatening. Decisions regarding whether to use a tocolytic and which tocolytic to use require the diagnosis of preterm labor, knowledge of the patient's gestational age, medical conditions, and cost. Once tocolysis is initiated, attention must be paid to the patient's response, side-effects, and adverse events. Larger studies are needed which incorporate, in addition to efficacy, data on safety and side-effect profiles and cost.

Blood transfusion in obstetrics: The pregnant women's point of view

SummaryThe objective of this study was to determine the views and compliance of a group of pregnant women regarding obstetric-related blood transfusion. In this prospective questionnaire-based analysis, a total of 300 pregnant women who attended the antenatal care clinic were included. The mean age and gestational age of patients were 31.6 years and 27.4 weeks, respectively. All demographic and questionnaire data were recorded and analysed. A total of 41% of participants were aware of the possible need for blood transfusion in pregnancy and 88% of all women would accept blood transfusion when necessary. The remaining 12% would refuse blood transfusion, even if it was life-saving, because of the fear of blood transfusion complications. It is concluded that counselling and a management plan should be scheduled for pregnancy, and management protocols should be developed for women who refuse blood transfusion. Transfusion alternatives should be discussed with women who will not accept the allogenic blood transfusion.

Evaluation of Neuroimaging in Cerebral Palsy

Objective Cerebral palsy (CP), a common static motor neurological disorder of childhood with wide spectrum of underlying etiologies, can be demonstrated with different neuro imaging techniques. We undertook this study to investigate the diagnosis of intracranial lesions in children with CP and its correlation between clinical deficits and neuroradiological findings. Materials and methods In this prospective hospital-based study, the data of 120 patients with CP, aged below 18 years, referring to the neurology clinic of the Ali Asghar Pediatric hospital in Tehran was studied; data on their cranial neuroimaging findings was analyzed any possible association(s) between the gestational ages, prenatal history and neurological deficits were investigated. Results Of the 120 patients, 72 (60%) were male; 75% were aged below 7 years. Common predisposing factors were prenatal asphyxia, LBW, prematurity and toxemia of pregnancy. Of the 120 cases, 90%(107) had spastic CP, with the quadriplegic type being the most common (54%), followed by spastic paraplegia (21%); twenty-four patients (20%) had significant Preventricular Leucomalacia (PVL), a finding more common among those born pre-term. Sixteen patients had hemiplegic CP, 14 of whom showed unilateral lesions on brain MRI imaging. Ten (8%) had extra pyramidal CP, a condition more common among term born infants, while six of the 10(72%) showed significant abnormalities on the basal ganglia. Cerebral atrophy was seen in 60 (50%) of patients and PVL in 20%; encephalomalacia, gliosis, middle cerebral artery infarcts, PVL and gliosis indicated hypoxia as a risk factor for CP. Extent of MRI lesions correlated with the severity of neurological deficits in CP lesions, which were more extensive in Quadriplegics and double hemiplegics rather than paraplegics, and among those delivered preterm as compared to those born at term. Conclusion Radiological findings were found to be closely related to the type of CP and the neurological deficits and gestational ages of patients with brain insult; we believe that MRI is helpful in delineating the underlying etiology, extent, severity and timing of insult to the developing brain and prognostication in CP patients.

Limits of viability: definition of the gray zone

As survival and long-term morbidity of very preterm infants have improved over the past decade, the limits of infant viability, the level of maturity below which survival and/or acceptable neurodevelopmental outcome are extremely unlikely, have also decreased. In an effort to define the current limits of infant viability, the data in the literature on survival and long-term neurodevelopmental outcome in very preterm neonates have been reviewed. The gestational age and birth weight below which infants are too immature to survive, and thus provision of intensive care is unreasonable, appears to be at <23 weeks and <500 g, respectively. Infants born at > or =25 weeks' gestation and with a birth weight of > or =600 g are mature enough to warrant initiation of intensive care, as the majority of these patients survive, and at least 50% do so without severe long-term disabilities. Finally, for infants born between 23(0/7) and 24(6/7) weeks' gestation and with a birth weight of 500 to 599 g, survival and outcome are extremely uncertain. For these infants born in the so-called 'gray zone' of infant viability, the line between patient autonomy and medical futility is blurred, and medical decision-making becomes even more complex and needs to embrace careful consideration of several factors. These factors include appraisal of prenatal data and the information obtained during consultations with the parents before delivery; evaluation of the patient's gestational age, birth weight and clinical condition upon delivery; ongoing reassessment of the patient's response to resuscitation and intensive care and continued involvement of the parents in the decision-making process after delivery. Based on these findings an algorithm is offered for consideration for neonatologists managing infants born in the 'gray zone' of infant viability. However, caution must be exercised when one considers incorporating this guideline into clinical practice because the algorithm is based on the analysis of the findings in the literature and the authors' experience rather than direct evidence.

PS02 ATRESIA OF THE JEJUNUM AND ILEUM: THE DISTINCTION

Purpose Atresia of the jejunum and ileum is one of the major causes of neonatal intestinal obstruction. Most affected newborn infants present with bilious emesis and abdominal distention. Traditionally, jejunal and ileal atresia have been grouped together as jejunoileal atresia. From our observation and experience, we found many differences regarding clinical features and outcome between these two groups. The purpose of this study is to elucidate the difference between jejunal and ileal atresia.Methodology A retrospective analysis of patients diagnosed with jejunal or ileal atresia during 1991–2005 was carried out.Results There were 68 patients with jejunal atresia and 56 with ileal atresia. The mean birth weight and gestational age of patients with jejunal atresia were significantly lower than those with ileal atresia. Antenatal perforation occurred more frequently in ileal atresia. Postoperative course was more prolonged and mortality was higher in jejunal atresia. Prolonged ileus and anastomotic dysfunction requiring long‐term parenteral nutrition were the major causes of complications leading to death.Conclusion There were many differences between patients with jejunal atresia and those with ileal atresia. The more compliant jejunal wall allows massive dilatation upon obstruction with subsequent loss of peristaltic activity, thus poorer outcome in comparison with ileal obstruction. We suggest that atresia of the jejunum and ileum be considered distinctly.

Timing of planned repeated caesarean section: An enigma

SummaryWe aimed to explore the current trends among obstetric consultants in timing planned caesarean sections in patients with previous caesarean deliveries. A questionnaire was sent to 129 consultant obstetricians and gynaecologists. The questionnaire included closed questions about the preferred gestational age to perform an elective caesarean section in patients with previous one, two, three or more caesarean deliveries and in patients with a previous classical caesarean scar. The study was confined to NHS hospitals at the Eastern and London Deaneries, UK. The main outcome measure was the gestational age at which a planned caesarean section was preferred. The percentage of consultants who preferred to do caesarean section at 39 weeks or more gestational age in patients with previous one, two, three or more and a classical caesarean section were 93.6%, 87.3%, 71.3% and 35.9%, respectively. A considerable body of obstetricians plan to perform elective caesarean sections at a gestational age <39 weeks in patients with three or more previous abdominal deliveries and in patients with a previous classical caesarean section. There are no randomised controlled trials to address the best practice in these cases. Looking at the available evidence in the literature, it seems unjustified to perform the caesarean section at an earlier gestational age for patients with previous multiple caesarean sections but there is some evidence to support this policy in patients with a previous classical section.

Therapeutic Levels of Intravenous Procainamide in Neonates: A Retrospective Assessment

To evaluate dosing and pharmacokinetic parameters of intravenous continuous-infusion procainamide in neonates, and to identify dosage regimens and factors leading to therapeutic procainamide levels and minimal adverse events. Retrospective, observational study. Pediatric hospital. . Twenty-one patients (seven preterm, 14 full term) younger than 30 days who received continuous-infusion procainamide therapy for more than 15 hours or had two consecutive therapeutic procainamide levels obtained while receiving therapy between June 1, 2002, and December 31, 2005. Data on demographics, dosing, drug levels, and adverse effects were collected. Doses that achieved therapeutic levels were documented, and procainamide clearance was calculated and evaluated with regard to renal function and gestational age in patients who were at steady state. Mean clearance and mean N-acetylprocainamide (NAPA):procainamide ratios were compared between preterm and term neonates. No patients experienced hemodynamic instability or other adverse effects due to procainamide. Procainamide was given as a mean +/- SD 9.6 +/- 1.5-mg/kg bolus in 20 of 21 patients before continuous infusion. The mean +/- SD dose at which two therapeutic levels were achieved was 37.56 +/- 13.52 microg/kg/minute. Procainamide clearance was 6.36 +/- 8.85 ml/kg/minute and correlated with creatinine clearance (r=0.78, p<0.00001) and age at day of sampling (r=0.49, p<0.00001). The NAPA:procainamide ratio at steady state was 0.84 +/- 0.53; two patients were determined to be fast acetylators (ratio > 1). Preterm infants had lower mean clearance rates (p<0.001) but higher NAPA:procainamide ratios (p<0.01) than those of term infants. Five patients experienced seven supratherapeutic levels while receiving therapy; four of these patients were preterm, and all had creatinine clearances less than 30 ml/minute/1.73 m(2). Three patients had four pairs of levels obtained after discontinuation of procainamide, and elimination rate constant and half-life were calculated. Procainamide can be safely used in neonates, with no short-term adverse effects. The dosage regimen for intravenous procainamide required to achieve therapeutic levels in neonates is similar to that of older infants and children. Doses may need to be reduced in premature infants and in those with renal dysfunction.

ECLAMPSIA

Objective: To evaluate incidence, morbidity and mortalityassociated with eclampsia. Design: A prospective study. Place and Duration: The study which was carried out at PAFHospital Rafiqui, Shorkot spanned over a period of 2½ years from Jun 2002-Dec 2004. Patients and Methods: Thestudy comprises of 55 eclamptic cases diagnosed out of 3391 consecutive deliveries, carried out in our hospital.Results: The incidence of eclampsia, in this study, was found to be 1.62%. Out of 55 cases 38(69.1%) patients wereprimigravida. Forty three (78.2%) of the patients were between the ages of 21 to 30 years. In 50(90.9%) patientsgestational age was less than 35 weeks. Thirty seven (67.3%) cases had antepartum eclampsia. Forty four (80%)patients received diazepam while the remaining 11(20%) received magnesium sulphate (MgSO4) as anticonvulsant.Commonest mode of delivery was spontaneous vaginal delivery \(31 cases, 56.4%) followed by lower caesareansection (21 cases, 38.2%). Fetal loss was seen in 12(20.7%) cases. Two patients died of eclampsia, maternal mortalityrate being 3.6%. Conclusion: Eclampsia is a life threatening complication of pregnancy. However an improvement inantenatal care, upgrading the neonatal facilities and early delivery by cesarean section can improve the perinataloutcome.

Increased immunohistochemical expression of thrombomodulin at placental perivascular myofibroblast in severe preeclampsia (PE).

The presence of pro-coagulant and anti-coagulant components of the placental vascular endothelium and syncytiotrophoblast are essential for homeostasis. Vascular endothelium prevents blood clot formation in vivo by involving a cell surface thrombin-binding glycoprotein, thrombomodulin (TM), that activates plasma anti-coagulant protein C. The TM levels increase during pregnancy, but the fibrinolytic capacity diminishes. Since vascular lesions with placental coagulation disorders can be associated with preeclampsia (PE), we hypothesized that TM expression in the stem villous vasculature and syncytiotrophoblast of the placenta are impaired in PE. Plasma and placental tissue samples were collected from PE (n=12) and normotensive pregnant patients (n=11). Patient's gestational age was 35.7+/-1.2 (normotensive) and 30.6+/-1.5 weeks (PE). Blood samples were drawn 30 min before delivery. Serum PAI-1 and PAI-2 antigens were determined by enzyme-linked immunoabsorbent assay (ELISA). A monoclonal antibody specific for TM was used for immunohistochemical tissue staining (ABC) and the staining was quantified by semi quantitative scores. Results show no intensity differences at the apical syncytiotrophoblast between the two groups. However, in preeclamptic placenta, TM expression diminished in the endothelium of the stem villi arteries and increased in the perivascular and stromal myofibroblats in cases of severe PE. TM changes were associated with an increased PAI-1/PAI-2 ratio. It is suggested that in severe PE, the decreased placental blood flow may be due to structural and functional impairment of the endothelium of the stem villi vessels and the surrounding perivascular and stromal myofibroblast, by increasing TM expression which may modulate fetal blow flow in the villous tree.

Prostaglandin receptors in lower segment myometrium during gestation and labor

Objective: To determine if expression of relaxatory prostaglandin (PG) E 2 receptors (EP 2 isoform) and contractile PG F receptors (FP isoform) changes during gestation and with labor in pregnant human myometrium. Methods: Lower segment myometrium was removed at cesarean from four groups of parturients (preterm [28–36 weeks] or term [37–41 weeks], either in or not in labor, ten per group). Myometrial RNA was isolated and used for reverse transcription-polymerase chain reaction (PCR) analysis with specific primer sets for human smooth muscle protein calponin and PGEP 2 or FP receptor isoform mRNA. Polymerase chain reaction products were electrophoresed on gels and visualized, band intensity was measured, and EP 2 and FP receptor expression was normalized to calponin. Results: Reverse transcription-PCR yielded products of expected sizes, and restriction enzyme cleavage confirmed identities. Prostaglandin EP 2 receptor isoform mRNA expression (relative to calponin mRNA) was significantly greater in the preterm, no labor group (1.28 ± 0.22, mean ± standard error of the mean [SE]) compared with the term, no labor group (0.71 ± 0.09) ( P < .05 Student-Neuman-Kuels) and declined significantly with gestational age in patients not in labor ( R = −.446, P = .001). Prostaglandin FP receptor isoform mRNA expression was significantly less in the term, no labor group (0.61 ± 0.06) compared with all others ( P < .02 Student-Neuman-Kuels). Prostaglandin FP receptor expression declined significantly with gestational age in patients not in labor ( R = −.646, P = .012) and increased significantly with labor at term. Conclusion: Changes in prostaglandin EP 2 receptor isoform expression are consistent with influence on maintenance of quiescence. Labor at term is associated with a significant increase in FP receptor expression, consistent with influence on contraction. The balance between the two receptor isoforms might mediate myometrial contractility.

Prostaglandin Receptors in Lower Segment Myometrium During Gestation and Labor

In Brief Objective To determine if expression of relaxatory prostaglandin (PG) E2 receptors (EP2 isoform) and contractile PG F receptors (FP isoform) changes during gestation and with labor in pregnant human myometrium. Methods Lower segment myometrium was removed at cesarean from four groups of parturients (preterm [28–36 weeks] or term [37–41 weeks], either in or not in labor, ten per group). Myometrial RNA was isolated and used for reverse transcription-polymerase chain reaction (PCR) analysis with specific primer sets for human smooth muscle protein calponin and PGEP2 or FP receptor isoform mRNA. Polymerase chain reaction products were electrophoresed on gels and visualized, band intensity was measured, and EP2 and FP receptor expression was normalized to calponin. Results Reverse transcription-PCR yielded products of expected sizes, and restriction enzyme cleavage confirmed identities. Prostaglandin EP2 receptor isoform mRNA expression (relative to calponin mRNA) was significantly greater in the preterm, no labor group (1.28 ± 0.22, mean ± standard error of the mean [SE]) compared with the term, no labor group (0.71 ± 0.09) (P < .05 Student-Neuman-Kuels) and declined significantly with gestational age in patients not in labor (R = −.446, P = .001). Prostaglandin FP receptor isoform mRNA expression was significantly less in the term, no labor group (0.61 ± 0.06) compared with all others (P < .02 Student-Neuman-Kuels). Prostaglandin FP receptor expression declined significantly with gestational age in patients not in labor (R = −.646, P = .012) and increased significantly with labor at term. Conclusion Changes in prostaglandin EP2 receptor isoform expression are consistent with influence on maintenance of quiescence. Labor at term is associated with a significant increase in FP receptor expression, consistent with influence on contraction. The balance between the two receptor isoforms might mediate myometrial contractility. Expression of relaxatory prostaglandin E2 receptor isoforms in pregnant lower segment myometrium decreases toward term, whereas contractile prostaglandin F receptor expression increases with labor at term.

Development of High Myopia, Strabismus and Anisometropia in Premature Infants

Patients and Methods:109 premature infants examined between January 1991 and January 1996 were followed for a mean time of 39 months. Sixty six had ROP and forty three had normal retinal examinations. All of them were refracted using cycloplegic retinoscopy at 3 months, 12 months and 18 months. Strabismus was detected by the Krimsky method.Results:We found a high correlation of strabismus, high myopia (>/=5.00 D.) and anisometropia (difference of spherical equivalent > 2.00 D. between the eyes) with the presence of ROP and increasing severity of retinopathy of prematurity. The presence of myopia and high myopia was not related to either treatment for ROP stage 3 or to the class of treatment.Conclusion:Strabismus, anisometropia and high myopia had no association to low birth weight or low gestational age in patients with ROP, but anisometropia and high myopia were related to younger gestational age when the tests of correlation were done to the total population of premature babies included in the study. The presence of ROP and increasing severity of it were predictors of myopia and high myopia.

The incidence and severity of shoulder dystocia correlates with a sonographic measurement of asymmetry in patients with diabetes.

The objective of this paper is to examine the relationship between fetal asymmetry measured sonographically and the incidence and severity of shoulder dystocia in diabetic patients. Ultrasound data were collected retrospectively from examinations of women with gestational and pregastational diabetes who delivered at University of California, Irvine Medical Center from 1993-1995. Sonographic fetal asymmetry was quantified by calculating the difference between the abdominal diameter and the biparietal diameter in centimeters (AD-BPD). The residual AD-BPD was a patient's actual AD-BPD at the time of the ultrasound minus the mean AD-BPD obtained in our population at the patient's gestational age. The correlations between fetal asymmetry and the incidence and severity of shoulder dystocia were assessed using an analysis of variance as well as a logistic regression analysis. Mild shoulder dystocia was defined as a delivery requiring McRobert's maneuver and/or suprapubic pressure, while severe shoulder dystocia was assessed when delivery of the posterior arm with Wood's corkscrew maneuver was required. One hundred twenty-three women met the inclusion criteria for the study. Dividing the cohort into three groups based on AD-BPD residual values resulted in the following AD-BPD residual ranges and incidences of shoulder dystocia: Group I, -1.80 to -0.32 cm (9.8%), Group II, -0.31 to 0.32 cm (19.5%), and Group III .33 to 2.0 cm (34.1%), (p <0.03). The residual AD-BPD difference correlated with the incidence of shoulder dystocia after controlling for maternal age, weight, parity, birth weight, and the gestational age at ultrasound (P <0.03). Similar results were found with regards to dystocia severity as the mean residual AD-BPD difference between those with no dystocia, mild dystocia, and severe shoulder dystocia was -0.09, 0.23, and 0.46 cm, respectively, (p <0.006). The residual AD-BPD correlated with the severity of shoulder dystocia after controlling for the above-mentioned confounding variables (p <0.05) in a regression analysis. There is a direct correlation in diabetic patients between the level of fetal truncal asymmetry measured sonographically and the incidence and severity of shoulder dystocia.

Pregnancy Outcome Beyond 41 Weeks Gestation

Abstract Objective: To determine maternal and perinatal morbidity and the spontaneous labor rate beyond 41 weeks of gestation. Method: Patients with uncomplicated pregnancy were recruited at 41 weeks and screened for fetal or maternal well-being. Following observation between 41 and 42 weeks, patients were randomized to either serial monitoring by cardiotocography and measurement of amniotic fluid index, or to immediate induction. Comparisons were made using the χ 2 test. Results after 42 weeks were analyzed according to intention at randomization. Results: Morbidity was not increased before 42 weeks. After 42 weeks, the cesarean section rate and incidence of meconium below the vocal cords were increased in monitored patients. The median gestational age in patients who were monitored was 298.5 (294–321) days. In patients observed from 41 weeks, 91.6% labored spontaneously. Conclusion: It is reasonable to observe uncomplicated pregnancy until 42 weeks with adequate monitoring. After 42 weeks, induction of labor is preferred.

Pregnancy outcome beyond 41 weeks gestation

Objective: To determine maternal and perinatal morbidity and the spontaneous labor rate beyond 41 weeks of gestation. Method: Patients with uncomplicated pregnancy were recruited at 41 weeks and screened for fetal or maternal well-being. Following observation between 41 and 42 weeks, patients were randomized to either serial monitoring by cardiotocography and measurement of amniotic fluid index, or to immediate induction. Comparisons were made using the χ 2 test. Results after 42 weeks were analyzed according to intention at randomization. Results: Morbidity was not increased before 42 weeks. After 42 weeks, the cesarean section rate and incidence of meconium below the vocal cords were increased in monitored patients. The median gestational age in patients who were monitored was 298.5 (294–321) days. In patients observed from 41 weeks, 91.6% labored spontaneously. Conclusion: It is reasonable to observe uncomplicated pregnancy until 42 weeks with adequate monitoring. After 42 weeks, induction of labor is preferred.